Recording of outpatient consultations

Patient-Reported Use of Personalized Video Recordings to Improve Neurosurgical Patient-Provider Communication

Background: Providing patients with a video recording of their visit with a medical professional is a common-sense method for improving patient-provider communication.

Objective: To describe the patient and provider experiences to video recording clinical medical encounters and providing the patient with a copy of the video for informational purposes.

Methods: Since 2009, over 2,800 patients of eight different neurosurgeons chose to be video recorded during their encounter with the doctor and were provided access to the recording to watch over again as a way to recall what the doctor had said. The video system was set up as a handheld video camera, and video files were downloaded and made accessible to patients via a secure Internet patient portal. Between 2012 and 2014, patients who participated were surveyed regarding their use of the video and what was recorded on the video. The experience of the providers from a clinical and medico-legal standpoint was also reviewed.

Results: Three hundred and thirty-three responses to the survey were received (39.2% response rate). More than half of patients (N=333; 56.2%) watched their video more than once, and over two-thirds (N=333; 68.6%) shared their video with a family member, friend, or another physician. Patients self-reported improved memory after watching their videos (N=299; 73.6% could remember more) and 50.2% responded that having the video made them feel more “at ease” with their medical problem (N=299). Overall, 88.0% of respondents indicated that their video had been helpful to them, and 98.5% would recommend having future visits video recorded. No patient made a comment that the video was intrusive or had prevented them from being open with their doctor. Finally, in the high-risk specialty of neurosurgery, none of the 2,807 patients who have been recorded since 2009 have used a video in a medico-legal action.

Conclusions: Patient responses to the recording system and having a copy of their video were very positive. Most respondents indicated that they had improved memory as well as decreased anxiety about their neurosurgical problem. There have been no legal challenges to date from giving patients access to the video recording. Our results indicate that the benefits to patients for expanding the use of video in medicine may outweigh perceived risks to providers.

Recordings or summaries of consultations for people with cancer

BACKGROUND

Many people find it difficult to remember information provided during medical consultations. One way of improving this may be to provide a record of the conversation.

OBJECTIVES

This review examined the effects of providing recordings or summaries of their consultations to people with cancer and their families.

SEARCH STRATEGY

We searched the following sources: The Cochrane Library (issue 2 2007); MEDLINE (1966 to 29 May 2007); CINAHL (1982 to 29 May 2007); Dissertation Abstracts (1861 to 29 May 2007; Index to Theses 29 May 2007; EMBASE (1985 to 29 May 2007); PsycINFO (1967 to 29 May 2007); AMED (1985 to 29 May 2007); British Nursing Index (1985 to May 2007); SCI-EXPANDED, SSCI (1986 to 3 June 2007); and Sociological Abstracts (1998 to 29 May 2007). For the initial (1999) publication of this review we also searched the following databases: Sociofile; Cancerlit; IAC Health & Wellness; JICST; Pascal; ERIC; ASSIA; Linguistics and Language Behavior Abstracts; Mental Health Abstracts; CAB Health; DHSS-Data; MANTIS.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials that evaluate the effects of providing recordings (for example, audiotapes) or summaries (for example, a letter with reminders of key points) of consultations to people with cancer or their families.

DATA COLLECTION AND ANALYSIS

Two authors assessed studies for inclusion. Data were extracted by one author and checked by another author. We assessed study quality on seven criteria. We used a systematic approach to data extraction to produce a descriptive summary of studies, and present a narrative synthesis of the results.

MAIN RESULTS

We included sixteen controlled trials involving 2318 adult participants. The studies measured diverse outcomes. Many of the participants found recordings or summaries of their consultations valuable, with between 60% and 100% of participants (across twelve studies) reading the summary or listening to the recording at least once. The recordings were used to help inform family and friends (range 41.5% to 94.4% of participants in nine studies). Five out of nine studies reported better recall of information for those receiving recordings or summaries. Three out of ten studies found that participants provided with a recording or summary were more satisfied. No studies (out of ten) found any statistically significant difference between groups in terms of anxiety or depression. Three studies evaluated the effects on quality of life, but found no main effects. No study evaluated the intervention's effects on survival.

AUTHORS' CONCLUSIONS

The provision of recordings or summaries of key consultations may benefit most adults with cancer. Although more research is needed to improve our understanding of these interventions, most patients find them very useful. Practitioners should consider offering people recordings or written summaries of their consultations.

Consultation audio tapes: an underused cancer patient information aid and clinical research tool

Patients with cancer are known to value consultation audio tapes as an information aid and frequently accept the offer to tape record their consultations with oncologists. Systematic reviews have shown that providing patients with an audio tape of their consultations improves how much information they remember. In surveys, many Australian doctors were unenthusiastic about providing consultation audio tapes to patients citing issues such as patient confidentiality and medico-legal concerns as reasons for their reluctance. In addition to clinical benefits, consultation audio tapes are a valuable research tool for documenting information provision and analysing the interactions between patients and oncologists. For example, audio tapes of clinical-trial consultations have raised concerns about the quality of informed consent given by patients. Consultation audio tapes have also been used to monitor strategies for improving patient understanding. In three randomised trials, provision of a question prompt sheet significantly increased the number of questions asked by patients about their prognosis, suggesting that this topic was not generally discussed adequately. Oncologists should consider installing audiotaping facilities and offer all patients a tape of their consultation. Furthermore, scientists who investigate doctor-patient interactions should consider using consultation audio tapes as a research tool.

Taping outpatient consultations: a survey of attitudes and responses of adult patients with ocular malignancy

PURPOSE

To study the attitudes and responses of cancer patients to audiotaped consultations as a communication aid in an ophthalmic clinic.

METHODS

Ninety-four patients attending an ocular oncology clinic were given an audiotape of their initial consultation. They were then administered a structured interview with questionnaire regarding their views on the tape when they attended an outpatient clinic for follow-up after surgery or radiotherapy.

RESULTS

91% of patients had listened to the tape at least once, often prior to their treatment or follow-up visit. Most patients had shared the tape with immediate relatives, including their spouse (58%) or other family members (45%). Of those who had listened to the tape, 94% described it as very useful or quite useful in helping them understand their condition. The majority had found it valuable in helping them understand their treatment and its side-effects, in reducing their fears and anxieties and in their emotional and psychological adjustment to their illness. Most commented on the tape as a valuable communication aid to the consultation process.

CONCLUSIONS

Taping of the consultation as a method of improving communication is popular among cancer patients. The vast majority benefit greatly from being able to hear their consultation again in their own time.

How to do it. Get patients' consent to enter clinical trials

Gaining patients' consent to enter clinical trials is essential, but not easy. Giving careful thought to the design of the study itself, information which patients receive, and the use of a signed consent form may all help. To be properly informed, patients need to know something about their condition, the proposed study, and alternative options. The type and amount of information will vary and investigators need to judge the level appropriate for each person. Patients should understand that taking part in a clinical trial is voluntary and that their decision will not affect the quality of care they receive. The process of obtaining consent requires time and good communication. Working with young, elderly, or mentally impaired patients, or those particularly vulnerable to coercion, requires special sensitivity to the potential dangers.